AP Exam 4 part VI Flashcards
which hypersensitivity reaction works by antigen-Ab complexes activating complement and destroying target cell
type II (cytotoxic)
transfusion reaction, erythoblastosis fetalis, acute transplant rejection, and MG are what types of hypersensitivity reactiosn
type II (cytotoxic)
SLE and RA are examples of what type of hypersensitivity reaction
type III (immune complex)
mediators for type III hypersensitivity reaction
IgG, IgM, neutrophils, complement
________________ reaction, is when an antigen-antibody complex forms and is deposited in tissues stimulating inflammation
type III (immune compelx)
poison ivy and transplant rejections are what type of hypersensitivity reaction
IV (delayed)
mediators for type IV hypersensitivity reaction
T cells, monocytes, macrophages, and cytokines
graves dz is what type of hypersensitivity reaction
V (stimulatory)
tx of anaphylaxis intraoperatively
- discontinue triggering agent 2. trendelenburg 3. FiO2 = 100% 4. epinephrine 5. fluids (NS/LR 10-30 mL/kg) 6. secondary tx
grade II anaphylactic reaction would require what dose of epi and what route?
10-20 mcg; SC/IM/IV
grade III anaphylactic reaction would require wht dose of epi and what route
100-200 mcg SC/IM/IV q 1-2 min; 1-4 mcg/min
grade IV anaphylactic reaction would require what dose or epi
1 mg IV repeat as needed: 0.05 - 1 mcg/min
secondary tx for intraop anaphylaxis with epinephrine unresponsiveness
- vasopressin 2-10 units IV 2. norepi: 0.05 - 0.1 mg/kg/min
pt has anaphylaxis intraoperatively, what is your secondary tx if they are having bronchospasm 2/2 that
- albuterol or ipratropium inhalants 2. terbutaline 0.25 mg SC (repeat in 15-30 min)
if pt is having intraoperative anaphylaxis 2/2 preoperative Beta blockade, what is your 2ndary tx?
glucagon 1-5 mg IV q5min
if pt is having anaphylaxis intraoperatively a secondary tx to consider is antihistamines, which ones?
- diphenhydramine or hydroxyzine 0.5-1.0 mg/kg IV 2 & ranitidine 50 mg IV
pt has intraoperative anaphylaxis, and has airway edema, what is the 2ndary tx?
hydrocortisone 100-250 mg IV
surgery and anesthesia are associated with a generalized state of _______________________
immunosuppression
factors contributing to the perioperative immune system dysfunction
- surgery 2. blood transfusion 3. hyperglycemia 4. hypothermia 5. general anesthetics 6. opioids
definition of a surgical site infection
one that occurs at or near the surgical incision within 30 days of the procedure, or within 1 year after implantation of prosthetic device
surgical site infections accout for ________% of all hospital acquired or nosocomial infections in hospitalized pts
31
the ____________ immune system is activated during surgery –> systemic _____________ within hours of procedure
innate; inflammation
what is the neuroendocrine response to surgery?
elevated: epi, NE and cortisol
how can we (as anesthesia providers) help in preventing surgical site infections?
Abx within 1 hour of cut time and sterile technique
surgical excision of tumor may stimulate what?
proliferation and metastasis of tumor cells
reasons that surgical excision of tumors can lead to proliferation and metastasis of tumor cells
- excision disrupts vessels supplying tumor –> allowsing them into systemic circ 2. catecholamines (released with surgery) promote angiogenesis 3. angiogenesis increased postop –> tissue repair at surgical site, but contributes to tumor growth and metastasis
how do blood transfusions effect on immune system
- they depress the immune system 2. increase incidence of SSI 3. promote earlier recurrence of cancer
what type of blood products are recommended for cancer patients ?
irradiated or leukocyte depleted blood products to offset the depression of the immune system by donor leukocytes
use of intraoperative cells savers (i.e. recycling blood) contributes to ___________________ in cancer pts
recurrence of cancer
hyperglycemia effect on the immune system
- depression of innate and adaptive immune systems 2. increases SSI and poor patient outcomes
T/F: even transient episodes of hyperglycemia can depress immune fx
TRUE
a blood glucose level between ________________ can decrease the effects of hyperglycemia on the immune system
140-180
effects of hypothermia perioperatively on the immune system
- increases blood loss 2. impairs wound healing 3. decreases immune function 4. increases need for blood transfusion –> even further decrease in immune system
_________________ anesthesia attenuates surgical stress response and preserves normal immune fx
regional
opioids suppress fx of _______________ cell activity
natural killer
volatile anesthetics on cancer recurrence
conflicting evidence; insufficient evidence to avoid in cancer surgery
N2O effect on cancer reccurence?
no effect
L.A. effect on cancer recurrence
decreased cancer recurrence and metastasis
neuraxial anesthesia effect on cancer recurrence
reduce recurrence and metastasis
NSAIDs affect on cancer recurrence
acute or chronic use associated with tumor regression (beneficial choice)
ASA affect on cancer
reduces cancer metastasis
opoids effect on cancer recurrence
promotes cancer progression and decreased long term survivial
supplemental O2 > ___________% postoperatively have shorter cancer free survival period
80
dexmethasone effect on cancer recurrence
no effect on cancer recurrence or survival
anesthetic technique on immunocompromised pt
- strict aseptic technique and maximum barrier precautions 2. GA or RA or combined 3. prophylactic Abx administered 30 min prior to incision 4. active warming measures to avoid hypothermia 5. perioperative management of blood glucose to avoid hyperglycemia 6. leukocyte poor/irradiated blood products should be used when transfusion unavoidable 7. multimodal approach for postop pain control (regional + nonopioids)
T/F: the overall risk related to anesthesia has declined
TRUE
death attributable to anesthesia is ______________
rare
there is lack of consensus on time frame for “anesthesia-related mortality,” but could be btwn _____-_____ post-anesthesia
24h; 30 days
________________ hypersensitivity reaction is mediated by IgE, mast cells, and basophils
type I
_______________ hypersensitivity reaction is mediated by IgG, IgM, compliment
type II (cytotoxic)
